秘，腹无满痛，神不甚昏，俱宜壮水滋阴，不可以为阳虚也。若黑苔望之虽燥而生刺，但渴不多饮，或不渴，其边或有
白苔，其舌本淡而润者，亦属假热，治宜温补，其舌心并无黑苔，而舌根有黑苔而燥者，宜下之，乃热在下焦也。若舌
本无苔，惟尖黑燥，为心火自焚，不可救药。上第十二章，唐本移为第十四章，今订正之。若（唐本无此字）舌黑而滑
者，水来克火，为阴证，当温之。若见短缩，此肾气竭也，为难治。欲救之（唐本作“惟”），加人参、五味子，勉希（唐
本作“或救”）万一。舌黑而干者，津枯火炽，急急泻南补北，若（唐本此下有“黑”字）燥而中心浓 （唐本无此字）
者，土燥水竭，急以咸苦下之。
何报之曰∶暑热证夹血，多有中心黑润者，勿误作阴证治之。
黑苔而虚寒者，非桂附不可治，佐以调补气血，随宜而施。若黑燥无苔，胃无浊邪。
雄按∶非无苔也，但不浓耳。
故当泻南方之火，补北方之水，仲景黄连阿胶汤主之。黑燥而中心浓者，胃浊邪热干结也，宜用硝、黄咸苦下之矣。
雄按∶上第十三章，唐本移为第十五章，今订正之。此二章言黑苔证治之，有区别也。
又按∶茅雨人云∶凡起病发热胸闷，遍舌黑色而润，外无险恶情状，此胸膈素有伏痰也，不必张皇，止用薤白栝蒌
桂枝半夏一剂，黑苔即退，或不用桂枝，即枳壳、桔梗亦效。
舌淡红无色者，或干而色不荣者，当是胃津伤而气无化液也，当用炙甘草汤。不可用寒凉药。
何报之曰∶红嫩如新生，望之似润而燥渴殆甚者，为妄行汗下，以致津液竭也。
淡红无色，心脾气血素虚也。更加干而色不荣，胃中津气亦亡也。故不可用苦寒药。炙甘草汤养气血以通经脉，其
邪自可渐去矣。
雄按∶上第十四章，唐氏移为第十一章，今订正之。此章言虚多邪少之人，舌色如是，当培气液为先也。
若舌白如粉而滑，四边色紫绛者，温疫病初入膜原，未归胃腑，急急透解，莫待传陷而入为险恶之病。且见此舌者，
病必见凶，须要小心。凡斑疹初见，须用纸捻照见胸背两胁，点大而在皮肤之上者，为斑；或云头隐隐，或琐碎小粒者，
为疹。又宜见而不宜见多。按方书谓斑色红者属胃热，紫者热极，黑者胃烂，然亦必看外证所合，方可断之。
温疫白苔如积粉之浓，其秽浊重也，舌本紫绛，则邪热为浊所闭，故当急急透解。此五疫中之湿疫，又可主以达原
饮，亦须随证加减，不可执也。舌本紫绛，热闭营中，故多成斑疹，斑从肌肉而出，属胃；疹从血络而出，属经。其或
斑疹齐见，经胃皆热，然邪由膜原入胃者多，或兼风热之入于经络，则有疹矣。不见则邪闭，故宜见。多见则邪重，故
不宜多。但斑疹亦有虚实，虚实不明，举手杀人，故先生辨之如后。
雄按∶温热病舌绛而白苔满布者，宜清肃肺胃，更有伏痰内盛，神气昏瞀者，宜开痰为治。黑斑、蓝斑，亦有可治
者。余治胡季权、姚禄皆二案，载续编。徐月岩室案，附曾大父《随笔》中。
然而春夏之间，湿病俱发疹为甚，且其色要辨（唐本无此句）。如淡红色，四肢清，口不甚渴，脉不洪数，非虚斑即
阴斑。或胸微见数点，面赤足冷，或下利清谷，此阴盛格阳于上而见，当温之。
此专论斑疹不独温疫所有，且有虚实之迥别也。然火不郁，不成斑疹。若虚火力弱而色淡，四肢清者，微冷也。口
不甚渴，脉不洪数，其非实火可征矣，故曰虚斑。若面赤足冷，下利清谷，此阴寒盛格拒其阳于外，内真寒，外假热，
郁而成斑，故直名为阴斑也。须附桂引火归元，误投凉药即死，实火误补亦死，最当详辨也。
若斑色紫（唐本下有“而”字）小点者，心包热也。点大而紫，胃中热也。黑斑而光亮者热胜毒盛（唐本作“热极
毒炽”）。虽属不治，若其人气血充者，或根据法治之，尚可救。若黑而晦者必死。若黑而隐隐，四旁赤色火郁内伏，大用
清凉透发，间有转红成可救者。若夹斑带疹，皆是邪之不一，各随其部而泄。然斑属血者恒多，疹属气者不少，斑疹皆
是邪气外露之象，发出（唐本下有“之时”二字）宜神情清爽，为外解里和之意。如斑疹出而昏者，正不胜邪，内陷为
患，或胃津内涸之故。
此论实火之斑疹也。点小即是从血络而出之疹，故热在心包；点大从肌肉而出为斑，故热在胃。黑而光亮者，元气
犹充，故或可救；黑暗则元气败，必死矣。四旁赤色，其气血尚活，故可透发也。斑疹夹杂，经胃之热，各随其部而外
泄，热邪入胃，本属气分，见斑则邪属于血者多矣。疹从血络而出，本属血分，然邪由气而闭其血，方成疹也，必当两
清气血以为治也。既出而反神昏，则正不胜邪而死矣。
雄按∶上第十五章，详论温疫中斑疹证治之不同，唐氏移为第十六章，今订正之。
再有一种白 ，小粒如水晶色者，杨云∶平人夏月亦间有之。此湿热伤肺，邪虽出而气液枯也，必得甘药补之。或
未至久延，伤及气液，乃湿郁卫分，汗出不彻之故，当理气分之邪，或白如枯骨者多凶，为气液竭也。
雄按∶湿热之邪，郁于气分，失于轻清开泄，幸不传及他经，而从卫分发白 者，治当清其气分之余邪。邪若久郁，
虽化白 ，而气液随之以泄，故宜甘濡以补之。苟色白如枯骨者，虽补以甘药，亦恐不及也。上第十六章，唐氏移为第
十七章，今订正之。
杨按∶湿热素盛者，多见此证，然在温病中为轻证，不见有他患，其白如枯骨者，未经阅历，不敢臆断。
汪按∶白 ，前人未尝细论，此条之功不小。白如枯骨者，余曾见之，非惟不能救，并不及救，故俗医一见白 ，
辄以危言恐吓病家。其实白如水晶色者，绝无紧要，吾见甚多，然不知甘濡之法，反投苦燥升提，则不枯者亦枯矣。
再温热之病，看舌之后，亦须验齿。齿为肾之余，龈为胃之络。热邪不燥胃津，必耗肾液，且二经之血，皆走其地，
病深动血，结瓣于上。阳血者色必紫，紫如干漆；阴血者色必黄，黄如酱瓣。阳血若见，安胃为主；阴血若见，救肾为
要。然豆瓣色者多险，若证还不逆者尚可治，否则难治矣。何以故耶？盖阴下竭，阳上厥也。
肾主骨，齿为骨之余，故齿浮龈不肿者，为肾火水亏也。胃脉络于上龈，大肠脉络于下龈，皆属阳明，故牙龈肿痛
为阳明之火。若湿入胃，则必连及大肠，血循经络而行，邪热动血而上结于龈。紫者为阳明之血，可清可泻。黄者为少
阴之血，少阴血伤为下竭，其阳邪上亢而气厥逆，故为难治也。
雄按∶上第十七章，唐氏移作第十八章，今订正之。
齿若光燥如石者，胃热甚也。若无汗恶寒，卫偏胜也，辛凉泄卫透汗为要。若如枯骨色者，肾液枯也，为难治。若
上半截润，水不上承，心火上炎也。急急清心救水，俟枯处转润为妥。
胃热甚而反恶寒者，阳内郁而表气不通，故无汗而为卫气偏胜，当泄卫以透发其汗，则内热即从表散矣。凡恶寒而
汗出者，为表阳虚，腠理不固，虽有内热，亦非实火矣。齿燥有光者，胃津虽干，肾气未竭也。如枯骨者，肾亦败矣，
故难治也。上半截润，胃津养之。下半截燥，由肾水不能上滋其根，而心火燔灼，故急当清心救水，仲景黄连阿胶汤主
之。
若切牙啮齿者，湿热化风，痉病。但切牙者，胃热气走其络也。若切牙而脉证皆衰者，胃虚无谷以内荣，亦切牙也，
何以故耶？虚则喜实也。舌本不缩而硬，而牙关咬定难开者，此非风痰阻络，即欲作痉证，用酸物擦之即开，木来泄土
故也。
牙齿相啮者，以内风鼓动也。但咬不啮者，热气盛而络满，牙关紧急也。若脉证皆虚，胃无谷养，内风乘虚袭之入
络，而亦切牙，虚而反见实象，是谓虚则喜实，当详辨也。又如风痰阻络为邪实，其热盛化风欲作痉者，或由伤阴而挟
虚者，皆当辨也。
雄按∶上第十八章，唐氏移作第十九章，今订正之。
若齿垢如灰糕样者，胃气无权，津亡，湿浊用事，多死。而初病齿缝流清血，痛者，胃火冲激也；不痛者，龙火内
燔也。齿焦无垢者，死；齿焦有垢者，肾热胃劫也。当微下之，或玉女煎清胃救肾可也。
齿垢由肾热蒸胃中浊气所结，其色如灰糕，则枯败而津气俱亡，肾胃两竭，惟有湿浊用事，故死也。齿缝流清血，
因胃火者出于龈，胃火冲激故痛；不痛者出于牙根，肾火上炎故也。齿焦者肾水枯，无垢则胃液竭，故死；有垢者，火
盛而气液未竭。故审其邪热甚者，以调胃承气微下其胃热；肾水亏者，玉女煎清胃滋肾可也。
雄按∶上第十九章，唐氏移作第二十章，今订正之。以上三章，言温热诸证可验齿面辨其治也。真发从来所未发，
是于舌苔之外更添一秘诀，并可垂为后世法。读者苟能隅反，则岂仅能识别温病而已哉。
再妇人病温与男子同，但多胎前产后，以及经水适来适断。大凡胎前病，古人皆以四物加减用之，谓护胎为要，恐
来害妊，如热极用井底泥、蓝布浸冷，覆盖腹上等，皆是保护之意，但亦要看其邪之可解处。用血腻之药不灵，又当省
察，不可认板法。然须步步保护胎元，恐损正邪陷也。
保护胎元者，勿使邪热入内伤胎也。如邪犹在表分，当从开达外解，倘执用四物之说，则反引邪入内，轻病变重矣。
杨云∶此释极为明通。故必审其邪之浅深而治，为至要也。若邪热逼胎，急清内热为主，如外用泥布等盖覆，恐攻热内
走，反与胎碍，更当详审，勿轻用也。总之，清热解邪，勿使伤动其胎，即为保护。若助气和气以达邪，犹可酌用。其
补血腻药，恐反遏其邪也。
雄按∶此说固是，然究是议药不议病矣。如温热已烁营阴，则地黄未尝不可用。且《内经》
曰∶“妇人重身，毒之何如？岐伯曰∶有故有殒，亦无殒也。大积大聚，其可犯也，衰其大半而止，不可过也。”故如伤
寒阳明实热证，亦当用承气下之，邪去则胎安也。盖病邪浅则在经，深则在腑，而胎系于脏，攻其经腑，则邪当其药，
与脏无碍。
雄按∶此释极通，而竟忘却温热传营入血之证，本文但云∶“不可认板法”，非谓血药无可用之证也。若妄用
补法以闭邪，则反害其胎矣。倘邪已入脏，虽不用药，其胎必殒而命难保。
雄按∶亦须论其邪入何脏。所以经言有故无
殒者，谓其邪未入脏，攻其邪亦无殒胎之害也。杨云∶有故无殒者，有病则病当之也。不必增入邪未入脏之说，以滋荧
惑。故要在辨证明析，用法得当，非区区四物所能保胎者也。故先生曰∶须看其邪之可解处，不可认板法，至哉言乎！
至于产后之法，按方书谓，慎用苦寒，恐伤其已亡之阴也。然亦要辨其邪能从上中解者，稍从证用之，亦无妨也。
不过勿犯下焦，且属虚体，当如虚怯人病邪而治。总之，无犯实实虚虚之禁。况产后当气血沸腾之候，最多空窦，邪势
必乘虚内陷，虚处受邪为难治也。
雄按∶余医案中，所载产后温热诸证治，皆宜参阅，兹不赘。
徐洄溪曰∶产后血脱，孤阳独旺，虽石膏、犀角对证，亦不禁用。而世之庸医，误信产后宜温之说，不论病证，皆
以辛热之药，戕其阴而益其火，无不立毙。我见甚多，惟叶案中绝无此弊，足征学有渊源。
魏柳洲曰∶近时专科及庸手，遇产后一以燥热温补为事，杀人如麻。
雄按∶不挟温热之邪者且然，况兼温热者乎。
吴鞠通曰∶产后温证，固云治上不犯中，然药反不可过轻，须用多备少服法，中病即已。所谓无粮之师，利于速战，
若畏产后虚怯，用药过轻，延至三四日后，反不能胜药矣。
如经水适来适断，邪将陷（唐本下有“于”字）血室，少阳伤寒，言之详悉，不必多赘。但数动与正伤寒不同，仲
景立小柴胡汤，提出所陷热邪，参、枣（唐本下有“以”字）扶胃气，以冲脉隶属阳明也，此与（唐本作“惟”）虚者为
合治。若热邪陷入，与血相结者，当从陶氏小柴胡汤去参、枣，加生地、桃仁、楂肉、丹皮或犀角等。若本经血结自甚，
必少腹满痛。轻者，刺期门；重者，小柴胡汤去甘药，加延胡、归尾、桃仁。挟寒，加肉桂心。气滞者，加香附、陈皮、
枳壳等。沈月光用柴胡、秦艽、荆芥、香附、苏梗、浓朴、枳壳、当归、芎 、益母草、木通、黄芩，名和血逐邪汤。
姜衣少许为引。治伤寒热入血室，气滞血瘀，而胸满、腹胀痛甚者，甚效。然热陷血室之证，多有谵语如狂之象，防是
阳明胃实（唐本作“与阳明胃实相似”下有“此种病机”四字），当辨之（唐本作“最须辨别”）。血结者，身体必重，非
若阳明之轻旋便捷者（唐本无“旋捷”二字），何以故耶？阴主重浊，络脉被阻（唐本下有“身之”二字），侧旁气痹，
连（唐本下有“及”字）胸背皆拘束不遂（唐本作“皆为阻窒”）。故祛邪通络，正合其病，往往延久，上逆心包，胸中
（唐本下有“痹”字）痛，即陶氏所谓血结胸也。王海藏出一桂枝红花汤加海蛤、桃仁，原是表里上下一齐尽解之理，
舌苔发黑，但腹部没有胀满疼痛，神志不是特别昏沉，都适宜采用壮水滋阴的方法治疗，不能认为是阳虚。如果舌苔黑，看起来虽然干燥且生刺，但口渴却不怎么喝水，或者不渴，舌边或许还有白苔，舌体本身淡而湿润的，也属于假热，治疗应当温补。如果舌心并没有黑苔，只有舌根有黑苔且干燥的，适宜用攻下法，这是热邪在下焦的缘故。如果舌本（舌面）没有苔，唯独舌尖黑而干燥，这是心火自焚，无法救治。以上第十二章，在唐本中被移为第十四章，现在予以订正。如果舌黑而滑润的，是水来克火，属于阴证，应当温治。如果出现舌体短缩，这是肾气竭绝的表现，属于难治之症。想要挽救（唐本作“惟”），加入人参、五味子，希望能有万分之一的希望（唐本作“或救”）。舌黑而干燥的，是津液枯竭、火势炽盛，必须紧急泻南方之火（清心火）、补北方之水（滋肾阴）。如果（唐本此下有“黑”字）燥而舌中心苔厚浓（唐本无此字）的，是土燥水竭，必须紧急用咸苦性质的药物攻下。
何报之说：暑热证夹带血分病变，多有舌中心黑而润泽的情况，不要误当作阴证来治疗。
黑苔而表现为虚寒的，非用肉桂、附子不可治疗，辅以调补气血的药物，根据具体情况施治。如果是黑燥而无苔，说明胃中没有浊邪。
王士雄按语：并非没有苔，只是不厚浓罢了。
所以应当泻南方之火，补北方之水，张仲景的黄连阿胶汤主治此类情况。如果是黑燥而舌中心苔厚浓的，是胃中浊邪热结，适宜用芒硝、大黄等咸苦药物攻下。
王士雄按语：以上第十三章，在唐本中被移为第十五章，现在予以订正。这两章论述了黑苔证治的区别。
又按：茅雨人说：凡是起病发热胸闷，全舌黑色而润泽，外部没有险恶症状的，这是胸膈素有伏痰，不必惊慌，只用薤白、瓜蒌、桂枝、半夏一剂，黑苔即可消退；或者不用桂枝，改用枳壳、桔梗也有效。
舌色淡红而无色的，或者干燥而色泽不荣润的，应当是胃津受伤而气无法化生津液，应当使用炙甘草汤。不可使用寒凉药物。
何报之说：舌色红嫩如新生，望起来似乎润泽但实际上极度干燥口渴的，是因为妄用发汗和攻下法，导致津液枯竭。
舌色淡红无色，是心脾气血素来虚弱。再加上干燥而色泽不荣润，说明胃中的津气和阴液也已亡失。所以不可使用苦寒药物。炙甘草汤能养气血以通经脉，邪气自然可以逐渐去除。
王士雄按语：以上第十四章，唐氏将其移为第十一章，现在予以订正。这一章论述的是虚多邪少的人，舌色如此，应当以培补气液为先。
如果舌苔白如粉状且滑润，四周边缘颜色紫绛的，这是温疫病初入膜原，尚未归入胃腑，必须紧急透解，不要等到传变陷入成为险恶的疾病。而且见到这种舌象，病情一定凶险，必须小心。凡是斑疹初现，须要用纸捻照看胸背两胁，点大且在皮肤之上的，称为斑；或者云头隐隐约约，或者琐碎小粒状的，称为疹。斑疹又宜见而不宜多见。按照方书说法，斑色红的属胃热，紫的热极，黑的胃烂，但也必须结合外部证候来判断，才能确诊。
温疫白苔如积粉般浓厚，说明秽浊之气重，舌本紫绛，说明邪热被浊气闭塞，所以应当紧急透解。这是五疫中的湿疫，可用达原饮为主方，但也必须随证加减，不可固执不变。舌本紫绛，热闭营分，所以多形成斑疹。斑从肌肉而出，属胃；疹从血络而出，属经。或者斑疹同时出现，是经和胃都有热，然而邪气由膜原传入胃的多，或者兼有风热侵入经络，则有疹。不见斑疹则邪气闭塞，所以宜见。多见则邪气重，所以不宜多。但是斑疹也有虚实之分，虚实不明，举手之间就会杀人，所以先生辨析如下。
王士雄按语：温热病舌质绛而白苔满布的，适宜清肃肺胃；更有伏痰内盛，神志昏蒙的，适宜化痰治疗。黑斑、蓝斑，也有可治的。我治疗胡季权、姚禄的两案，记载在续编中。徐月岩妻子的案，附在我曾祖父《随笔》中。
然而在春夏之间，湿病发作时出疹较多，而且其颜色需要辨别（唐本无此句）。如果是淡红色，四肢清凉，口不怎么渴，脉不洪数，这不是虚斑就是阴斑。或者胸部微见几点，面赤足冷，或者下利清谷，这是阴盛格拒阳气于上而显现，应当温治。
这里专门论述斑疹，不仅温疫有，而且有虚实明显的区别。然而火不郁结，就不能形成斑疹。如果虚火力弱而颜色淡，四肢凉的，是微冷。口不怎么渴，脉不洪数，这就证明不是实火，所以叫虚斑。如果面赤足冷，下利清谷，这是阴寒盛，格拒阳气于外，内真寒，外假热，郁结而成斑，所以直接称为阴斑。必须用附子、肉桂引火归元，误投凉药就会死亡，实火误补也会死亡，最应当详细辨别。
如果斑色紫（唐本下有“而”字）点小者，是心包热。点大而紫，是胃中热。黑斑而光亮者，是热胜毒盛（唐本作“热极毒炽”）。虽然属于不治之症，但如果病人气血充盛的，或者依照法治之，还可以挽救。如果黑而晦暗的必死。如果黑而隐隐约约，四周赤色，是火郁内伏，大用清凉透发之法，间或有转红变成可救的。如果夹斑带疹，都是邪气不一，各随其部位而泄出。然而斑属血的居多，疹属气的不少，斑疹都是邪气外露的现象，发出（唐本下有“之时”二字）时应当神情清爽，这是外解里和的意思。如果斑疹出而昏沉的，是正气不胜邪气，内陷为患，或者是胃津内涸的缘故。
这里论述的是实火的斑疹。点小即是从血络而出的疹，所以热在心包；点大从肌肉而出为斑，所以热在胃。黑而光亮的，元气犹充，所以或许可以救；黑暗则元气败，必死。四周赤色，气血尚活，所以可以透发。斑疹夹杂，是经胃之热，各随其部位而外泄，热邪入胃，本属气分，见斑则邪气属于血的多矣。疹从血络而出，本属血分，然而邪气由气分闭塞血分，才形成疹，必须两清气血来治疗。既出而反神昏，则是正气不胜邪气而死。
王士雄按语：以上第十五章，详细论述温疫中斑疹证治的不同，唐氏将其移为第十六章，现在予以订正。
再有一种白㾦，小粒如水晶色的，杨云说：普通人夏天也偶尔会有。这是湿热伤肺，邪气虽出但气液枯耗，必须用甘药补益。或者未到久延，伤及气液，乃是湿郁卫分，汗出不彻的缘故，应当调理气分之邪。如果白㾦如枯骨色的多凶，这是气液竭绝。
王士雄按语：湿热之邪，郁于气分，失于轻清开泄，幸而没有传及其他经，而从卫分发白㾦的，治疗应当清其气分的余邪。邪气若久郁，虽然化为白㾦，但气液随之泄耗，所以适宜甘濡以补之。如果颜色白如枯骨的，即使补以甘药，恐怕也来不及了。以上第十六章，唐氏将其移为第十七章，现在予以订正。
杨按：湿热素盛的人，多见此证，然而在温病中属于轻证，不见有其他病患。至于白㾦如枯骨的，未曾阅历过，不敢臆断。
汪按：白㾦，前人未曾详细论述，此条功劳不小。白㾦如枯骨的，我曾见过，不仅不能救，甚至来不及救，所以俗医一见白㾦，就用危言恐吓病人家属。其实白㾦如水晶色的，绝无紧要，我见过很多，然而不知道甘濡之法，反而投用苦燥升提的药，那么原本不枯的也变得枯了。
再温热病，看舌之后，也必须验齿。齿为肾之余，龈为胃之络。热邪不燥胃津，必耗肾液，而且二经之血，皆走其地，病深动血，结瓣于上。阳血的颜色必紫，紫如干漆；阴血的颜色必黄，黄如酱瓣。见到阳血，以安胃为主；见到阴血，以救肾为要。然而豆瓣色者多险，如果证候还不逆乱的尚可治，否则难治。为什么呢？这是因为阴下竭，阳上厥。
肾主骨，齿为骨之余，所以齿浮龈不肿的，是肾火水亏。胃脉络于上龈，大肠脉络于下龈，皆属阳明，所以牙龈肿痛是阳明之火。如果湿入胃，则必连及大肠，血循经络而行，邪热动血而上结于龈。紫者为阳明之血，可清可泻。黄者为少阴之血，少阴血伤为下竭，其阳邪上亢而气厥逆，所以难治。
王士雄按语：以上第十七章，唐氏将其移作第十八章，现在予以订正。
牙齿如果光燥如石头的，是胃热甚。如果没有汗恶寒，是卫偏胜，辛凉泄卫透汗是关键。如果像枯骨色的，是肾液枯，为难治。如果上半截润，是水不上承，心火上炎。必须紧急清心救水，等到干枯处转润才妥当。
胃热甚而反恶寒的，是阳内郁而表气不通，所以无汗而为卫气偏胜，当泄卫以透发其汗，则内热即从表散。凡恶寒而汗出的，是表阳虚，腠理不固，虽有内热，也不是实火。齿燥有光的，胃津虽干，肾气未竭。如枯骨的，肾也败了，所以难治。上半截润，由胃津滋养。下半截燥，由肾水不能上滋其根，而心火燔灼，所以急当清心救水，张仲景的黄连阿胶汤主治。
如果切牙啮齿的，是湿热化风，痉病。只切牙的，是胃热气走其络。如果切牙而脉证皆衰的，是胃虚无谷以内荣，也切牙，为什么呢？虚则喜实。舌本不缩而硬，而牙关咬定难开的，这不是风痰阻络，就是欲作痉证，用酸物擦之即开，木来泄土的缘故。
牙齿相啮的，以内风鼓动。只咬不啮的，是热气盛而络满，牙关紧急。如果脉证皆虚，胃无谷养，内风乘虚袭之入络，而也切牙，虚而反见实象，是谓虚则喜实，应当详细辨别。又如风痰阻络为邪实，其热盛化风欲作痉的，或由伤阴而挟虚的，都应当辨别。
王士雄按语：以上第十八章，唐氏将其移作第十九章，现在予以订正。
如果齿垢如灰糕样的，是胃气无权，津亡，湿浊用事，多死。而初病齿缝流清血，痛的，是胃火冲激；不痛的，是龙火内燔。齿焦无垢的，死；齿焦有垢的，是肾热胃劫。应当微下之，或者玉女煎清胃救肾也可。
齿垢由肾热蒸胃中浊气所结，其色如灰糕，则枯败而津气俱亡，肾胃两竭，惟有湿浊用事，故死。齿缝流清血，因胃火者出于龈，胃火冲激故痛；不痛者出于牙根，肾火上炎故也。齿焦者肾水枯，无垢则胃液竭，故死；有垢者，火盛而气液未竭。所以审其邪热甚的，以调胃承气微下其胃热；肾水亏的，玉女煎清胃滋肾也可。
王士雄按语：以上第十九章，唐氏将其移作第二十章。以上三章，讲温热诸证可验齿面辨其治。真发从来所未发，是在舌苔之外更添一秘诀，并可垂为后世法。读者若能隅反，则岂仅能识别温病而已哉。
再妇人病温与男子同，但多胎前产后，以及经水适来适断。大凡胎前病，古人皆以四物汤加减用之，谓护胎为要，恐来害妊，如热极用井底泥、蓝布浸冷，覆盖腹上等，皆是保护之意，但也须要看其邪之可解处。用血腻之药不灵，又当省察，不可认板法。然须步步保护胎元，恐损正邪陷也。
保护胎元者，勿使邪热入内伤胎。如邪犹在表分，当从开达外解，倘执用四物之说，则反引邪入内，轻病变重。杨云：此释极为明通。故必审其邪之浅深而治，为至要。若邪热逼胎，急清内热为主，如外用泥布等盖覆，恐攻热内走，反与胎碍，更当详审，勿轻用。总之，清热解邪，勿使伤动其胎，即为保护。若助气和气以达邪，犹可酌用。其补血腻药，恐反遏其邪。
王士雄按语：此说固是，然究是议药不议病。如温热已烁营阴，则地黄未尝不可用。且《内经》曰：“妇人重身，毒之何如？岐伯曰：有故有殒，亦无殒也。大积大聚，其可犯也，衰其大半而止，不可过也。”故如伤寒阳明实热证，亦当用承气下之，邪去则胎安。盖病邪浅则在经，深则在腑，而胎系于脏，攻其经腑，则邪当其药，与脏无碍。
王士雄按语：此释极通，而竟忘却温热传营入血之证，本文但云：“不可认板法”，非谓血药无可用之证。若妄用补法以闭邪，则反害其胎。倘邪已入脏，虽不用药，其胎必殒而命难保。
王士雄按语：亦须论其邪入何脏。所以经言有故无殒者，谓其邪未入脏，攻其邪亦无殒胎之害。杨云：有故无殒者，有病则病当之。不必增入邪未入脏之说，以滋荧惑。故要在辨证明析，用法得当，非区区四物所能保胎。故先生曰：须看其邪之可解处，不可认板法，至哉言乎！
至于产后之法，按方书谓，慎用苦寒，恐伤其已亡之阴。然亦要辨其邪能从上中解者，稍从证用之，亦无妨。不过勿犯下焦，且属虚体，当如虚怯人病邪而治。总之，无犯实实虚虚之禁。况产后当气血沸腾之候，最多空窦，邪势必乘虚内陷，虚处受邪为难治。
王士雄按语：我医案中，所载产后温热诸证治，皆宜参阅，兹不赘。
徐洄溪说：产后血脱，孤阳独旺，虽石膏、犀角对证，亦不禁用。而世之庸医，误信产后宜温之说，不论病证，皆以辛热之药，戕其阴而益其火，无不立毙。我见甚多，惟叶案中绝无此弊，足征学有渊源。
魏柳洲说：近时专科及庸手，遇产后一以燥热温补为事，杀人如麻。
王士雄按语：不挟温热之邪者且然，况兼温热者乎。
吴鞠通说：产后温证，固云治上不犯中，然药反不可过轻，须用多备少服法，中病即已。所谓无粮之师，利于速战，若畏产后虚怯，用药过轻，延至三四日后，反不能胜药。
如经水适来适断，邪将陷（唐本下有“于”字）血室，少阳伤寒，言之详悉，不必多赘。但数动与正伤寒不同，张仲景立小柴胡汤，提出所陷热邪，参、枣（唐本下有“以”字）扶胃气，以冲脉隶属阳明，此与（唐本作“惟”）虚者为合治。若热邪陷入，与血相结者，当从陶氏小柴胡汤去参、枣，加生地、桃仁、楂肉、丹皮或犀角等。若本经血结自甚，必少腹满痛。轻者，刺期门；重者，小柴胡汤去甘药，加延胡、归尾、桃仁。挟寒，加肉桂心。气滞者，加香附、陈皮、枳壳等。沈月光用柴胡、秦艽、荆芥、香附、苏梗、浓朴、枳壳、当归、芎 、益母草、木通、黄芩，名和血逐邪汤。姜衣少许为引。治伤寒热入血室，气滞血瘀，而胸满、腹胀痛甚者，甚效。然热陷血室之证，多有谵语如狂之象，防是阳明胃实（唐本作“与阳明胃实相似”下有“此种病机”四字），当辨之（唐本作“最须辨别”）。血结者，身体必重，非若阳明之轻旋便捷（唐本无“旋捷”二字），为什么呢？阴主重浊，络脉被阻（唐本下有“身之”二字），侧旁气痹，连（唐本下有“及”字）胸背皆拘束不遂（唐本作“皆为阻窒”）。故祛邪通络，正合其病，往往延久，上逆心包，胸中（唐本下有“痹”字）痛，即陶氏所谓血结胸。王海藏出一桂枝红花汤加海蛤、桃仁，原是表里上下一齐尽解之理，
If the tongue coating is black, but there is no abdominal distension or pain, and the mental state is not severely confused, all are suitable for treatment with "strengthening water and nourishing yin" (Zhuang Shui Zi Yin), and should not be considered as yang deficiency. If the tongue coating is black, appearing dry and prickly to the eye, yet the patient drinks little despite thirst, or has no thirst, and the edges may have white coating while the tongue body itself is pale and moist, this also belongs to false heat; treatment should employ warming and tonifying methods. If the center of the tongue has no black coating, but the root has black coating that is dry, purgative methods are suitable, indicating heat in the lower jiao. If the tongue body has no coating, only the tip is black and dry, this is "heart fire self-burning" (Xin Huo Zi Fen) and is incurable. The above Chapter 12 was moved to Chapter 14 in the Tang edition; it is now corrected. If the tongue is black and slippery, it represents water overcoming fire, belonging to a yin syndrome, and should be treated with warming. If tongue shortening is observed, this indicates exhaustion of kidney qi, which is difficult to treat. To attempt rescue (Tang edition reads "only"), add Ren Shen (Ginseng Root) and Wu Wei Zi (Schisandra Fruit); one may hope for a slim chance (Tang edition reads "or rescue"). If the tongue is black and dry, it signifies fluid exhaustion and blazing fire; urgently clear southern fire (clear heart fire) and supplement northern water (nourish kidney yin). If (the Tang edition adds the character "black" here) it is dry with a thick, concentrated coating at the center (absent in Tang edition), it indicates earth dryness and water exhaustion; urgently use salty and bitter purgatives.
He Baozhi stated: In summer-heat syndromes complicated by blood involvement, many present with a black and moist center of the tongue; do not mistakenly treat this as a yin syndrome.
For black coating presenting with deficiency-cold, only Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Prepared Aconite Root) are effective, assisted by formulas regulating and tonifying qi and blood, applied according to circumstances. If the coating is black, dry, and absent, there is no turbid pathogen in the stomach.
Wang Shixiong's note: It is not that there is no coating, merely that it is not thick or concentrated.
Therefore, one should clear southern fire and supplement northern water; Zhang Zhongjing's Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is the primary formula. If black and dry with a thick concentration at the center, it is turbid pathogenic heat knotting in the stomach; use salty and bitter purgatives like Xiaoshi (Sodium Sulfate) and Dahuang (Rhubarb Root and Rhizome).
Wang Shixiong's note: The above Chapter 13 was moved to Chapter 15 in the Tang edition; it is now corrected. These two chapters discuss the differentiation of black coating syndromes and treatments.
Furthermore: Mao Yuren said: Whenever onset involves fever and chest oppression, with the entire tongue black and moist, and no dangerous external symptoms, this indicates latent phlegm in the chest and diaphragm. There is no need for alarm; simply use Xie Bai (Macrostemon Rhizome), Gualou (Trichosanthes Fruit), Guizhi (Cinnamon Twig), and Banxia (Pinellia Tuber) in one dose, and the black coating will recede. Alternatively, omitting Guizhi and using Zhi Qiao (Aurantium Fructus) and Jiegeng (Platycodon Root) is also effective.
If the tongue is pale red without color, or dry and lacking luster, it indicates injury to stomach fluids where qi cannot transform into fluids; Zhigancao Tang (Licorice Decoction) should be used. Cold-cooling medicines must not be used.
He Baozhi stated: Tongue red and tender like new growth, appearing moist but actually suffering from extreme dryness and thirst, results from reckless sweating and purging, leading to fluid exhaustion.
Pale red without color indicates inherent deficiency of heart and spleen qi and blood. Added dryness and lack of luster indicate loss of stomach fluid qi and yin. Therefore, bitter-cold medicines are contraindicated. Zhigancao Tang nourishes qi and blood to unblock meridians, allowing pathogens to gradually dissipate.
Wang Shixiong's note: The above Chapter 14 was moved to Chapter 11 by Tang; it is now corrected. This chapter discusses cases where deficiency outweighs pathogen, with such tongue colors, emphasizing prioritizing the cultivation of qi and fluids.
If the tongue coating is white like powder and slippery, with purple-crimson edges, this indicates warm epidemic disease entering the membrane source (Mo Yuan) but not yet returning to the stomach fu organ. Urgently resolve and vent it; do not wait for transmission and sinking into dangerous pathology. Moreover, seeing this tongue indicates a severe prognosis, requiring caution. When macules and papules first appear, one must illuminate the chest, back, and hypochondrium with a paper torch. Large spots on the skin surface are macules (Ban); faint cloud-like patterns or tiny granular spots are papules (Zhen). They should appear but not excessively. According to medical texts, red macules belong to stomach heat, purple indicates extreme heat, and black indicates rotting stomach tissue; however, external signs must be combined for diagnosis.
In warm epidemics, thick white coating like accumulated powder indicates heavy turbidity; if the tongue body is purple-crimson, pathogenic heat is closed by turbidity, necessitating urgent resolution. This is damp-warm epidemic among the five epidemics; Keyi's Zhaoyin Yin (Origin-Reaching Decoction) can be used as the main formula, but must be modified according to symptoms; do not adhere rigidly. Purple-crimson tongue body indicates heat closing the Ying level, often resulting in macules and papules. Macules emerge from muscles and belong to the Stomach; papules emerge from blood collaterals and belong to the Meridians. If both appear simultaneously, both meridian and stomach are hot. However, pathogens usually enter the stomach from the membrane source; if accompanied by wind-heat entering meridians, papules occur. Absence indicates pathogen closure, so appearance is favorable. Excessive appearance indicates heavy pathogen, so it is unfavorable. However, macules and papules have excess and deficiency distinctions; failing to distinguish them can be fatal. Thus, the master differentiates as follows.
Wang Shixiong's note: In warm-heat diseases, if the tongue is crimson with widespread white coating, clearing and purifying Lung and Stomach is appropriate. If latent phlegm is abundant causing mental confusion, resolving phlegm is the treatment. Black and blue macules can also be treatable. My cases of Hu Jiquan and Yao Lu are recorded in the Continuation. The case of Xu Yueyan's wife is attached to my great-grandfather's "Random Notes."
However, during spring and summer, damp diseases manifesting as papules are severe, and their color must be distinguished (absent in Tang edition). If pale red, limbs are cool, mouth is not very thirsty, and pulse is not flooding and rapid, these are either deficiency macules or yin macules. If a few points appear slightly on the chest, face is red, feet are cold, or there is diarrhea with undigested food, this is yin excess repelling yang upward, manifesting externally; warming treatment is required.
This specifically discusses macules and papules, not exclusive to warm epidemics, highlighting distinct excess and deficiency types. Fire must be constrained to form macules and papules. If deficiency leads to weak fire, pale color, and cool limbs, it is slight cold. Mouth not very thirsty, pulse not flooding/rapid proves non-excess fire, hence "deficiency macules." If face red, feet cold, diarrhea with undigested food, this is yin-cold excess repelling yang outward, internal true cold, external false heat, constrained into macules, hence directly named "yin macules." Must use Fuzi (Prepared Aconite Root) and Guizhi (Cinnamon Twig) to guide fire back to its source; misusing cooling drugs causes death. Misusing tonics for excess fire also causes death; careful differentiation is crucial.
If macules are purple (Tang edition adds "and") small dots, it is Heart Pericardium heat. Large purple dots indicate Stomach heat. Black macules that are bright/lustrous indicate heat prevailing and toxin flourishing (Tang edition reads "heat extreme, toxin blazing"). Although considered incurable, if the patient has sufficient qi and blood, following proper treatment may save them. If black and dull, death is certain. If black and faint with surrounding redness, it is fire constrained internally; large doses of cooling and venting agents may occasionally turn red and become salvageable. If macules and papules mix, it indicates diverse pathogens, each draining according to their location. Macules mostly relate to blood; papules often relate to qi. Both are manifestations of pathogens emerging externally. Upon emergence (Tang edition adds "at the time"), mental clarity indicates exterior resolution and interior harmony. If confusion persists after emergence, righteous qi fails to overcome pathogens, leading to internal sinking, or due to internal depletion of stomach fluids.
This discusses excess-fire macules and papules. Small dots emerging from blood collaterals are papules, thus heat in Heart Pericardium; large dots emerging from muscles are macules, thus heat in Stomach. Black and bright indicates residual yuan qi, possibly salvageable; dark/black indicates yuan qi failure, certain death. Surrounding redness indicates active qi and blood, allowing venting. Mixed macules/papules involve meridian/stomach heat draining externally. Heat entering stomach belongs to Qi level; seeing macules implies pathogen relates more to Blood. Papules emerge from blood collaterals, originally Blood level, but formed when Qi pathogen blocks Blood; thus, clearing both Qi and Blood is necessary. Confusion after emergence means righteous qi loses to pathogen, leading to death.
Wang Shixiong's note: The above Chapter 15 details differences in macule/papule treatment in warm epidemics; Tang moved it to Chapter 16; now corrected.
Another type is Bai Bo (white papules), small grains like crystal color. Yang Yun said: Healthy people occasionally get them in summer. This is damp-heat injuring Lung; although pathogen exits, qi and fluids are exhausted; sweet-tonics are required. Or, if not prolonged to injure qi/fluids, it is damp constraining the Wei level, incomplete sweating; regulate Qi level pathogen. If Bai Bo looks like dead bone, prognosis is poor, indicating qi/fluid exhaustion.
Wang Shixiong's note: Damp-heat constrained in Qi level, missed by light-clearing venting,幸 avoiding other meridians, emerging as Bai Bo from Wei level; treat by clearing residual Qi pathogen. If pathogen constraints long, even if transforming into Bai Bo, qi/fluids drain; thus sweet-moistening tonification is needed. If color is white like dead bone, even sweet tonics may fail. The above Chapter 16 was moved to Chapter 17 by Tang; now corrected.
Yang noted: Those with inherent damp-heat abundance often show this; in warm diseases, it is mild, without other complications. Having never seen Bai Bo like dead bone, I dare not speculate.
Wang noted: Bai Bo was not discussed in detail by predecessors; this section is valuable. I have seen Bai Bo like dead bone; not only incurable, but too late to save. Thus, vulgar doctors frighten families upon seeing Bai Bo. Actually, crystal-colored Bai Bo is insignificant; I have seen many. However, not knowing sweet-moistening methods, instead using bitter-dry ascending drugs, turns non-exhausted into exhausted.
Regarding warm-heat diseases, after examining the tongue, teeth must also be checked. Teeth are the surplus of Kidney; gums are the network vessels of Stomach. Pathogenic heat not drying stomach fluids will consume kidney fluids; blood of both meridians flows to these areas. Deep disease moves blood, forming petals on top. Yang blood is purple, like dried lacquer; Yin blood is yellow, like soybean paste. Seeing Yang blood, prioritize calming Stomach; seeing Yin blood, prioritize saving Kidney. However, soybean-paste color is dangerous; if symptoms are not adverse, treatable; otherwise difficult. Why? Because yin exhausts below, yang reverses above.
Kidney governs bones; teeth are bone surplus. Floating teeth with non-swollen gums indicate kidney fire/water deficiency. Stomach network vessels connect to upper gums; Large Intestine network vessels connect to lower gums; both belong to Yangming. Thus, gum swelling/pain is Yangming fire. If damp enters Stomach, it affects Large Intestine; blood flows through collaterals, pathogenic heat moves blood upward to gums. Purple is Yangming blood, clearable/purgable. Yellow is Shaoyin blood; Shaoyin blood injury is lower exhaustion, with yang pathogen rising and qi reversal, making it difficult.
Wang Shixiong's note: The above Chapter 17 was moved to Chapter 18 by Tang; now corrected.
If teeth are shiny and dry like stone, stomach heat is severe. If no sweat and aversion to cold, Wei level dominance; pungent-cool venting Wei to induce sweat is key. If like dead bone color, kidney fluid exhaustion, difficult to treat. If upper half moist, water does not ascend, heart fire flares upward. Urgently clear heart and save water; wait for dry area to become moist.
Severe stomach heat with aversion to cold indicates internal yang constraint and blocked exterior qi, causing no sweat and Wei dominance; vent Wei to induce sweat, dispersing internal heat via exterior. Aversion to cold with sweat indicates exterior yang deficiency and insecure pores; even with internal heat, it is not excess fire. Dry teeth with shine indicate stomach fluid dry but kidney qi intact. Like dead bone indicates kidney failure, hence difficult. Upper half moist nourished by stomach fluid. Lower half dry because kidney water cannot nourish roots, while heart fire burns; urgently clear heart and save water; Zhang Zhongjing's Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is indicated.
Teeth grinding/chattering indicates damp-heat transforming into wind, spasm disease. Only grinding indicates stomach heat moving through collaterals. Grinding with deficient pulse/symptoms indicates stomach deficiency lacking grain to nourish; also grinds. Why? Deficiency prefers excess. Tongue stiff but not shortened, jaw locked hard open: not wind-phlegm blocking collaterals, but impending spasm; rub with sour substance to open, as Wood drains Earth.
Teeth gnashing indicates internal wind stirring. Only biting without gnashing indicates excessive heat filling collaterals, jaw tension. If pulse/symptoms deficient, stomach lacks grain, internal wind attacks collaterals via deficiency, causing grinding; deficiency showing excess signs, termed "deficiency prefers excess," requires careful differentiation. Wind-phlegm blocking collaterals is excess; heat transforming into wind impending spasm, or yin-injury with deficiency, all require differentiation.
Wang Shixiong's note: The above Chapter 18 was moved to Chapter 19 by Tang; now corrected.
Tooth plaque like gray cake indicates stomach qi powerless, fluid loss, damp-turbidity dominating; mostly fatal. Early stage bleeding from tooth gaps with pain indicates stomach fire rushing; painless indicates dragon fire internal burning. Teeth scorched without plaque: death. Teeth scorched with plaque: kidney heat, stomach plundered. Mild purgation or Yuniu Jian (Jade Woman Decoction) to clear stomach and save kidney is suitable.
Tooth plaque forms from kidney heat steaming stomach turbidity; gray cake color indicates decay, fluid/qi exhaustion, kidney/stomach dual exhaustion, only damp-turbidity remaining, hence fatal. Bleeding from gaps due to stomach fire comes from gums, painful due to rushing; painless comes from tooth roots, painful due to kidney fire rising. Scorched teeth indicate kidney water exhaustion; no plaque indicates stomach fluid exhaustion, hence death; with plaque indicates fire strong but qi/fluid not exhausted. Assess severe heat, mildly purge stomach heat with Tiaowei Chengqi Tang; assess kidney water deficiency, clear stomach/nourish kidney with Yuniu Jian.
Wang Shixiong's note: The above Chapter 19 was moved to Chapter 20 by Tang. These three chapters discuss diagnosing warm-heat via teeth/mouth. This reveals previously unpublished secrets beyond tongue coating, serving as future guidelines. Readers applying this analogically will recognize more than just warm diseases.
Women contracting warm diseases are similar to men, but often involve pre-natal/post-natal states or menstruation starting/stopping. Ancient texts generally used Siwu Tang (Four Substances Decoction) modifications for pre-natal illness, emphasizing protecting the fetus to prevent harm, e.g., using well-bottom mud or cold-soaked blue cloth on abdomen for extreme heat. All aim to protect, but must assess if pathogen can be resolved. If blood-nourishing greasy drugs fail, re-evaluate; do not apply rigid rules. Step-by-step protection of fetal origin is needed to prevent righteous qi damage and pathogen sinking.
Protecting fetal origin means preventing pathogenic heat from injuring fetus internally. If pathogen is still at Wei level, resolve externally via opening/dispersing; adhering strictly to Siwu Tang would draw pathogen inward, worsening mild disease. Yang Yun: This explanation is clear. Determining treatment based on pathogen depth is essential. If pathogenic heat forces fetus, urgently clear internal heat; external mud/cloth cover might drive heat inward, harming fetus; examine carefully, do not use lightly. Generally, clearing heat/resolving pathogen without injuring fetus constitutes protection. Assisting qi to reach pathogen can be酌情 used. Blood-nourishing greasy drugs may hinder pathogen.
Wang Shixiong's note: This view is correct but focuses on drugs rather than disease. If warm-heat scorches Ying-yin, Dihuang (Rehmannia Root) is usable. Also, *Neijing* states: "Pregnant woman, poison how? Qibo: With cause, there is destruction, also no destruction. Major accumulation/depression, can be attacked, reduce by more than half then stop, do not exceed." Thus, Yangming excess heat in cold damage also uses Chengqi purgation; pathogen removal ensures fetal safety. Pathogen shallow in meridians, deep in fu organs; fetus tied to zang organs. Attacking meridians/fu organs directs drug action to pathogen, sparing zang organs.
Wang Shixiong's note: This interpretation is thorough, yet forgets warm-heat transmitting to Ying/Blood levels. Text says "do not apply rigid rules," not that blood drugs are unusable. Recklessly using tonics to close pathogen harms fetus. If pathogen enters zang organs, even without drugs, fetus perishes and life endangered.
Wang Shixiong's note: Must discuss which zang organ pathogen enters. Hence scripture says "with cause no destruction," meaning if pathogen hasn't entered zang, attacking pathogen won't destroy fetus. Yang Yun: "With cause no destruction" means disease bears the impact. No need to add "pathogen not in zang" to confuse. Crucial is clear differentiation and proper method; Siwu Tang alone cannot protect fetus. Master said: "Assess if pathogen can be resolved, do not apply rigid rules." Profound words!
Regarding post-natal methods, texts advise caution with bitter-cold to avoid injuring already lost yin. However, differentiate if pathogen can resolve via upper/middle; slight symptomatic use is acceptable. Just avoid Lower Jiao. Since constitution is deficient, treat like weak person with pathogen. Overall, do not violate prohibitions against reinforcing excess or depleting deficiency. Post-natal period features boiling qi/blood, many empty spaces; pathogen inevitably sinks via deficiency; treating deficiency-receiving-pathogen is difficult.
Wang Shixiong's note: Refer to my medical records for post-natal warm-heat treatments; omitted here.
Xu Huixi said: Post-natal blood loss leaves lone yang rampant; even if Shigao (Gypsum) and Xijiao (Rhinoceros Horn - substitute with Buffalo Horn) are indicated, they are not forbidden. Yet vulgar doctors, believing post-natal warmth theory, use pungent-hot drugs regardless of condition, damaging yin and boosting fire, causing immediate death. I have seen much; Ye Tianshi's cases lack this flaw, proving profound learning.
Wei Liuzhou said: Recent specialists and quacks treat post-natal solely with dry-hot tonics, killing like flies.
Wang Shixiong's note: Even without warm-heat pathogen, this happens; what about with warm-heat?
Wu Jutong said: Post-natal warm disease, though treating upper avoids middle, drugs shouldn't be too light. Use "prepare much, take little" method; stop when hitting target. Like an army without supplies, favoring quick battle. Fear of post-natal weakness leading to light dosing delays treatment; by day 3-4, body cannot tolerate drugs.
If menstruation starts/stops, pathogen will sink into Blood Chamber (Xue Shi). Shaoyang cold damage discusses this thoroughly; no need to repeat. But frequent movement differs from standard cold damage. Zhang Zhongjing established Xiaochaihu Tang (Minor Bupleurum Decoction) to extract sunk heat; Renshen (Ginseng) and Dazao (Jujube) support Stomach qi, as Chong Mai belongs to Yangming. This suits deficiency. If heat sinks and knots with blood, follow Tao's modification of Xiaochaihu Tang: remove Renshen/Dazao, add Shengdi (Rehmannia Root), Taoren (Peach Kernel), Shanzha (Hawthorn Fruit), Mudanpi (Moutan Bark), or Xijiao (Buffalo Horn). If meridian blood knot is severe, lower abdomen full/painful. Mild: puncture Qimen (LR14). Severe: Xiaochaihu Tang remove sweet herbs, add Yanhu (Corydalis Rhizome), Guiwei (Angelica Root Tail), Taoren (Peach Kernel). With cold: add Rouguixin (Cinnamon Heart). Qi stagnation: add Xiangfu (Cyperus Rhizome), Chenpi (Tangerine Peel), Zhike (Aurantium Fructus). Shen Yueguang used Chaihu (Bupleurum Root), Qinjiao (Gentiana Macrophylla Root), Jingjie (Schizonepeta Spike), Xiangfu (Cyperus Rhizome), Sugeng (Perilla Stem), Houpo (Magnolia Bark), Zhike (Aurantium Fructus), Danggui (Angelica Sinensis Root), Xiong (Ligusticum Rhizome), Yimucao (Leonurus Herb), Mutong (Akebia Stem), Huangqin (Scutellaria Root), named He Xue Zhu Xie Tang (Harmonize Blood Expel Pathogen Decoction). Add small amount of Jiangyi (Ginger Skin) as guide. Effective for cold damage heat sinking into Blood Chamber with qi stagnation/blood stasis causing chest/abdominal fullness/pain. However, heat sinking into Blood Chamber often presents with delirium/raving; prevent similarity to Yangming Stomach excess (Tang edition adds "similar to Yangming Stomach excess" and "this pathogenesis"). Differentiate carefully (Tang edition reads "must distinguish most"). Blood knot causes heavy body, unlike Yangming's agility. Why? Yin governs heaviness/turbidity; collaterals blocked, side qi paralyzed, connecting chest/back stiffness/immobility (Tang edition reads "all obstructed"). Thus expelling pathogen/unblocking collaterals fits disease. Often prolongs, reversing to Heart Pericardium, chest pain (Tang edition adds "bi"), i.e., Tao's "Blood Knot Chest". Wang Haicang proposed Guizhi Honghua Tang (Cinnamon Twig and Safflower Decoction) plus Haige (Concha Arcae) and Taoren (Peach Kernel), originally resolving exterior-interior, upper-lower simultaneously.